Facial interface and headgear system for use with ventilation and positive air pressure systems

ABSTRACT

The present disclosure relates to a mask assembly system that has an adjustable headgear system with an inflatable cushion connected to the positive air pressure supply for conforming to a user&#39;s face.

PRIORITY CLAIM

Priority is claimed to co-pending U.S. Provisional Patent ApplicationSer. No. 62/025,073, filed Jul. 16, 2014, 62/025,077, filed Jul. 16,2014, and 62/049,994 filed Sep. 12, 2014 which are hereby incorporatedherein by reference in their entirety.

COPYRIGHT STATEMENT

A portion of the disclosure of this patent application document containsmaterial that is subject to copyright protection including the drawings.The copyright owner has no objection to the facsimile reproduction byanyone of the patent document or the patent disclosure as it appears inthe Patent and Trademark Office file or records, but otherwise reservesall copyright rights whatsoever.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to medical devices, and, more particularlyto mask and headgear portions of air delivery devices that assist withthe delivery of gas to the nasal passages of users. These mask andheadgear systems and devices may be used with positive airway pressure[PAP] such as continuous positive airway pressure devices [CPAP],automatic positive airway pressure devices [APAP], variable positiveairway pressure devices [VPAP], and bi-level positive airway pressuredevices [BPAP].

2. Description of the Prior Art

Nasal pillows exist to be partially inserted into a user's nare and forma seal with the nare(s), which allows for the user to breathe from theventilator or PAP device. However, nasal pillows have been known to notnecessarily form the best seals for all users, put unnecessary pressureon the nare region when held in place by a mask system, and limited onflexibility. Masks have also tended to be bulky and shift when wearingthem at night. Designs are being made to make masks lighter and moresecure.

A need therefore exists for a nasal pillow that is interchangeable witha mask system, which is flexible and adaptable to a user's nare andfacial profile, and reduces pressure applied on the nare region while inuse. A need also exists for an adjustable mask and headgear system thatconforms to a user's head and facial features while being comfortableand securely attaching the nasal pillows to a user's nares.

SUMMARY OF THE INVENTION

Contemplated herein is a facial interface and headgear system for usewith ventilation and positive air pressure systems. The facial interfacecan include a system and assembly configured to provide a portion ofcontinuous airway pressure to a user's airways.

In one embodiment a mask and headgear assembly is comprised of a maskframe, where the mask frame further comprises: a core having an inletconnector for receiving a supply of pressurized gas from a deliverytube; a right arm extending from the core; and a left arm extending fromthe core, wherein each of the right and left arms form an associated airpathway through each respective arm, wherein each arm includes an firstaperture for supplying the supply of pressurized gas to a patient'sairways; and a headgear interface located about a distal end of eacharm, the headgear interface being configured to be attached to aheadgear assembly, the headgear interface further comprising a secondaperture for communicating a portion of the supply of pressurized gas toan interior portion of the headgear assembly.

The mask and headgear assembly can further include an inflatable cushionconfigured to inflate in response to the supply of pressurized gasdelivered through the second aperture.

The inflatable cushion can include a deformable core configured to beselectively deformed and retain a deformed shape.

The inflatable cushion can include a plurality of CO₂ washout ventsprovided on an exterior wall. The plurality of CO₂ washout vents can beformed from knife-coating a silicone layer over a flexible material,where the material was previously gas permeable and the silicone layerformed thereon or partially embedded therein helps trap in oxygen, butenables CO₂ to escape through the silicone knife coated material.

The system can further include a nasal pillow assembly configured toconnect to each of the arms over the respective apertures. In thismanner each nasal pillow assembly can be configured to communicate thesupply of pressurized gas from the air pathway through each nasal pillowassembly and to a user's nostrils.

Optionally, a headgear interface can be provided which is located abouta distal end of each of the right and left arms, the headgear interfacebeing configured to be attached to a headgear assembly.

In some embodiments the right and left arms can be offset with respectto one another so as to be non-coaxial, or in other words angled withrespect to one another. In yet other embodiments the nasal pillowassembly includes a nasal pillow rotatable about a nasal pillow axis.

In some embodiments the headgear interface provided at each distal endof the left and right arms can include a deformable sidepiece configuredto attach to its respective arm. This deformable sidepiece can beconfigured to attach to the arm at various angular positions withrespect to the axis of its respective right or left arm. In someembodiments the deformable sidepiece as a planar member which isconfigured to be selectively deformed out of plane so as to conformabout the facial contours of a user, for example, to hold a shapecorresponding to the curvature of the user's cheeks. It will beappreciated that this deformable sidepiece represents a potentiallyuncomfortable situation wherein the deformable sidepiece could bepressed into the user's face. As such, a malleable cover, such as fabricor neoprene can be provided and configured to encompass the deformablesidepiece.

In some embodiments the nasal pillow assembly can further include anattachment sleeve configured to engage with each of the right and leftarms respectively and encompass the associated aperture. The attachmentsleeve can thus be configured to provide rotation of each pillowassembly about its respective arm without obstructing flow through therespective aperture. In some embodiments the attachment sleeve includesa radial hose connection for interfacing with its respective nasalpillow. This radial hose connection can be configured to allow for axialadjustable along the radial hose.

In yet other embodiments the attachment sleeve can be provided with oneor more washout vents. Alternatively, washout vents can be provided atdistal ends of the right and left arms, or about the core, or in anycombination of the same.

In some embodiments the nasal pillows can formed in the shape of a cone,the cone having an elliptical cross section. In this manner as thepillows are rotated about a central pillow axis, or about the axis ofthe radial hose the relative orientation of each pillow can be adjustedso as to match the nostrils or nares of the user.

In some embodiments the headgear can include a plurality of adjustablestraps so as to be adjustable to provide a desired retention force or adesired sealing force as well as be customizable so as to match thespecific contours of the user's head. In some embodiments one strap canbe configured to extend over a crown of the user's head, and in otherembodiments a strap can be configured to extend behind a rear portion ofthe user's head, or both.

The deformable sidepiece of the mask and headgear assembly can attach toeach arm using an interference interconnector comprising a maleconnection and a female connection located selectively about either thedeformable sidepiece or the interference interconnector.

In some embodiments the inlet connector can include a swivel connectorso as to provide a certain degree of flexibility with respect to an airsupply hose and the mask frame provided about the user's face, forexample if the user shifts while sleeping.

In some embodiments alternative core or mask frames can be devoid of anattachment sleeve or have arms that pivot about the core.

In some embodiments the core can be provided with a heat moistureexchange (HME) component 326 located within the central portion.Alternatively, the HME 326 can be provided within the air supply hose,or within the right or left arms

In yet additional embodiments a method of providing a pressurized streamof air using the device described above is contemplated. The method caninclude various steps, in varying combinations including: providing asupply of pressurized gas to a delivery tube; receiving the supply ofpressurized gas at an inlet of a core; selecting a pair of properlysized nasal pillows from a plurality of various nasal pillows, eachnasal pillow having a pillow aperture formed at a top end; affixing thepair of nasal pillows to the core over the respective apertures of eacharm such that the air pathway extends through the pillow aperture ofeach pillow; and positioning the nasal pillows such that the air pathwayextends to a user's respiratory system through the nasal pillows throughthe user's nares.

The method can also include the steps of: affixing a headgear assemblyto distal ends of both the right and left arms; and rotating the nasalpillows such that the elliptical cross section coincides with the user'sparticular nare shape, wherein each of the nasal pillows has anelliptical axial cross section.

These and other embodiments form some of the various inventive conceptsas contained herein. The individual embodiments as described are notintended to be limiting, but are intended only as illustrative of thevarious inventive concepts and are not intended to be limiting except asclaimed below.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, aspects, features, and advantages ofthe disclosure will become more apparent and better understood byreferring to the following description taken in conjunction with theaccompanying drawings, in which:

FIG. 1 illustrates a perspective view of a facial interface and headgearsystem for use with ventilation and positive air pressure systems;

FIG. 2 illustrates a front exploded view of the facial interface andheadgear system for use with ventilation and positive air pressuresystems of FIG. 1;

FIG. 3 illustrates a core or mask frame structure for use with thefacial interface and headgear system for use with ventilation andpositive air pressure systems of FIGS. 1-2;

FIG. 4 illustrates an exploded view of the core or mask frame structureof FIG. 3 illustrating a swivel adapter and heat moisture

FIG. 5 illustrates an exemplary headgear system attached to the core ormask frame structure of FIG. 3;

FIGS. 6A-E illustrate various exemplary nasal pillows and configurationsfor use with the ventilation and positive air pressure systems of FIGS.1-2;

FIG. 7 illustrates a top view of the ventilation and positive airpressure systems of FIGS. 1-2;

FIG. 8 illustrates an exemplary embodiment of a potential headgearconnection interface for use with the ventilation and positive airpressure systems of FIGS. 1-2;

FIG. 9 illustrates another exemplary embodiment of a potential headgearconnection interface for use with the ventilation and positive airpressure systems of FIGS. 1-2;

FIG. 10 illustrates a fitting for the potential headgear connectioninterface of FIG. 9;

FIG. 11 illustrates another alternative fitting for the potentialheadgear connection interface of FIG. 9;

FIG. 12 illustrates a perspective view of an assembly procedure usingthe headgear connection interface of FIG. 9;

FIG. 13 illustrates a perspective view of an assembly procedure of yetanother exemplary embodiment of a potential headgear connectioninterface for use with the ventilation and positive air pressure systemsof FIGS. 1-2;

FIG. 14 illustrates an alternative perspective view of the assemblyprocedure of the embodiment of FIG. 13;

FIG. 15 illustrates a perspective view of a user wearing yet anotherexemplary embodiment of a potential headgear connection interface foruse with the ventilation and positive air pressure systems of FIGS. 1-2;

FIG. 16 illustrates a perspective view of the assembled exemplaryembodiment of a potential headgear connection interface of FIG. 15;

FIG. 17 illustrates a perspective exploded view of the exemplaryembodiment of a potential headgear connection interface of FIG. 15;

FIG. 18 illustrates a perspective view of an assembly procedure of theexemplary embodiment of a potential headgear connection interface ofFIG. 15;

FIG. 18 illustrates a perspective view of another portion of theassembly procedure of the exemplary embodiment of a potential headgearconnection interface of FIG. 15;

FIG. 20 illustrates a perspective view of a user wearing yet anotherexemplary embodiment of a potential headgear connection interface foruse with the ventilation and positive air pressure systems of FIGS. 1-2;

FIG. 21 illustrates a perspective exploded view of a yet anotherexemplary embodiment of a potential headgear connection interface foruse with the ventilation and positive air pressure systems of FIGS. 1-2;

FIG. 22 illustrates a perspective view of yet another partiallyassembled exemplary embodiment of a potential headgear connectioninterface for use with the ventilation and positive air pressure systemsof FIGS. 1-2;

FIGS. 23A-C illustrate exploded side and front views, respectively, ofan alternative core or mask frame assembly for use with the ventilationand positive air pressure systems of FIGS. 1-2;

FIG. 24 illustrates an alternative embodiment of a mask frame havingadjustable arm portions;

FIG. 25 illustrates a perspective end view of a frame and a partial viewof an inflatable strap assembly in accordance with yet anotherembodiment of a headgear connection interface:

FIG. 26 illustrates a perspective end view of a frame and a partial viewof an inflatable strap assembly having a deformable core in accordancewith yet another embodiment of a headgear connection interface;

FIG. 27 illustrates a perspective end view of a frame and a partial viewof an inflatable strap assembly having a deformable core in accordancewith yet another embodiment of a headgear connection interface; and

FIGS. 28A-B illustrate a front view of a user wearing any one of theembodiments as shown in FIGS. 25-27 illustrating an uninflated andinflated configuration of an inflatable side strap.

Reference will now be made to the exemplary embodiments illustrated, andspecific language will be used herein to describe the same. It willnevertheless be understood that no limitation of the scope of theinvention is thereby intended though the exemplary embodimentsdiscussed, but the examples are for purposes of illustration of theinventive concepts.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

To provide an overall understanding of the systems, devices, and methodsdescribed herein, certain illustrative embodiments will be described.Although the embodiments and features described herein are frequentlydescribed for use in connection with CPAP apparatuses, systems, andmethods, it will be understood that all the components, mechanisms,systems, methods, and other features outlined below may be combined withone another in any suitable manner and may be adapted and applied toother PAP apparatuses, systems, and methods, including, but not limitedto, APAP, VPAP, and BPAP apparatuses, ventilators, systems, and methods.

The present application seeks to provide a solution to theaforementioned problems by creating an adjustable, comfortable, maskassembly system that has interchangeable components, light-weight, andadaptable to individual users.

FIGS. 1-2, and 7 illustrate various views of a positive airway pressureassembly 10 configured to aid in supplying a stream of positive pressureair to the airways of a patient wearing the assembly 10. The assemblyincludes a mask frame 300 having a pair of nasal pillow assemblies 100attached thereto. The mask frame 300 receives a stream of pressurizedair from a blower (not shown), which can be attached to the mask frame300 by means of a supply hose 30. The air then travels through the maskframe 300 through apertures 354 and through the associated pillowassemblies 100 to provide air into the nostrils or nares of the userwearing the positive airway pressure assembly 10.

The positive airway pressure assembly 10 can optionally include aheadgear system 20 configured to provide a sealing force between theindividual pillow assemblies 100 and the nostrils of the user. Incertain cases the headgear system 20 can also provide a positioningforce between the mask frame 300 and the maxilla of the user or patient,for example on the portion of the face between the upper lip and belowthe nose. It will be appreciated that the headgear assembly 20 can beformed of a resilient material, or be adjustable through various meansso as to conform to the individual user's contours which,understandably, vary between various users. Further, the headgearassembly 20 can also be configured to affix to distal ends of the maskframe 300 and can be configured to provide a certain degree ofrotational adjustment between the mask frame 300 and the headgear 20.

As shown in various figures, headgear 20 may be comprised of multiplestraps, such as one configured to go over the top portion of a user'shead, and second strap going generally about the back portion of auser's head. Either strap can have an adjustment mechanism, noadjustment mechanism, formed of resilient material, inflexible or formedin a variety of configurations including having a cover or sleeve formedover a portion of the straps or no cover or sleeve.

FIGS. 3-5 illustrate various aspects of the mask frame 300. It will beappreciated that air supply travels as shown by pathway arrows 60through the tube, through a central portion of the mask frame 300 andexits apertures 354. The apertures can have a pair of lips or shoulders358 upon or about which the pillow assembly 100 from FIGS. 1-2 can restand seal. The mask frame 300 can have a central portion 310 and left andright arms extending therefrom, 362 and 364 respectively. Each of theright and left arms can be provided with a headgear connection interface400 about their respective distal ends. The headgear connectioninterface allows for variation in the types of connectors used forconnecting the headgear (not shown here).

In some embodiments, the right and left arms can be provided asco-axial, i.e. straight with respect to each other, so as to reducefabrication complexity and cost. Alternatively, and as shown herein theright and left arms can be angled with respect to one another so as tobetter conform in shape to the front of the user's face, whichunderstandably typically has a curved profile.

In addition the mask frame or core 300 can be provided with an inletconnector 322 about the central portion. The inlet connector can beconfigured to swivel coaxially with the air supply hose 30. In additionthe core or mask frame 300 can be provided with a heat moisture exchange(HME) component within the core about the inlet connector 322. The HMEcan also be provided in alternative locations as well as in multiples,for example a pair of HME units could be provided within the nasalpillow assemblies or more proximal the apertures 354.

In particular, FIG. 5 illustrates how the headgear can be affixed to thecore or mask frame 300 through the use of one embodiment of a headgearconnection interface 400. This particular embodiment illustrates aswivel connection 322 which allows the headgear to rotate with respectto the distal ends of the mask frame 300.

FIGS. 6A-E illustrate various views of a nasal pillow assembly 100 foruse with the nasal mask frame as shown in FIGS. 3-5. The nasal pillowassembly 100 can include a nasal pillow 110 and attachment sleeves 150.The attachment sleeves 150 in this embodiment are configured to slideover the mask frame 300 and seal over apertures 354 by having an innershoulder 359 which abuts against and slidingly seals against theshoulders 358 as shown in FIG. 3. In this manner, the air delivered tothe mask frame can be redirected through the pillow assembly 100 andinto the user's nares. The attachment sleeve 150 can be provided with anattachment portion 154 for receiving the pillow 110. The attachmentportion 154 can be provided with a series of ribs or channels configuredto interface with a plurality of annular ribs 114 and/or channelsprovided on an annular tube (or stem) forming an attachment portion ofeach pillow 110.

In particular FIG. 6D illustrates an air conform bladder 162 which canbe formed as part of the attachment sleeve 150. The air conform bladder162 can be formed of a malleable or flexible material, and have a hollowcavity defined thereby which receives pressurized gas from the interiorof the attachment sleeve 150 when attached to the mask frame (not shownhere). In this manner, as the pressure rises or is increased when thesystem is on, the air conform bladder becomes partially inflated andacts similar to a balloon. The air conform bladder 162 can then restagainst the maxilla and provide an air cushioned interface between themask and the user's face. In some embodiments, the air conform bladderis formed directly on the core frame, as part of the nasal pillowsdevoid of an attachment sleeve, or a part of the attachment sleeveitself that can form in part the nasal pillow assembly.

The meshing or integration of the annular ribs 114 with the channels orribs 154 provided in the attachment sleeve allows for incrementaladjustment of the relative height or radial positioning of the nasalpillow 110 with respect to the attachment sleeve 150, and thereby themask frame or core, by changing which ribs are meshed with whichrespective channel. In this manner each nasal pillow can translateaxially with respect to a pillow axis thus providing a first degree offreedom 104A. Additionally, the ribs and channels can slide with respectto one another when twisted about the pillow axis providing a seconddegree of freedom 104B which is rotational about a central axis of eachpillow. Finally, the interior shoulder 359 can also slide with respectto its relative exterior shoulder of the mask frame 358 as shown in FIG.3. so as to allow the sleeve, and the associated pillow to rotate aboutthe axis of the right or left arm thus providing a third degree offreedom 104C. This sealing lip 359 allows for the attachment sleeve 150to rotate about the mask along the mask frame axis thus providing athird degree of freedom 104C. Additional flexibility in the system cancome from the nasal pillow itself. For example, the base portion of thenasal pillow, which functions like a trampoline or pivoting springallows for the head or conical portion of the nasal portion to tilt orpivot about the stem or annular tube. This is made possible by varyingthe thickness or durometer of the base portion with respect to the heador conical portion and the stem or annular tube.

FIG. 8 illustrates another embodiment of the headgear connector 400Awhich utilizes a contoured barb 404 and a corresponding barb receiver408. The barb can have a plurality of shapes including semi-sphericalshapes as shown, or any other conceivable geometric shape with acorrespondingly shaped receiver. In this embodiment the receiver isconfigured to be deformable or resilient so as to expand to initiallyaccept the barb 404 when press therein. After the barb 404 is pressedinto the receiver, an interference fit is formed and the barb willresist, to a certain degree, being pulled from the receiver 408.

FIGS. 9-12 illustrate yet another embodiment of a headgear connector400C which utilizes a connector 412 which has two ends, one forattaching to the distal end of the mask frame or core 300, and the otherfor interfacing with the headgear 20. The headgear interfacing end isprovided with an aperture 414 configured to receive a clip barb 416. Thecore end of the connector 412 has another corresponding aperture 416through which a plug 428 can be provided so as to affix the connector412 to the core 300. The two ends of the connector can be configured torotate with respect to one another, as illustrated between FIGS. 10 and11, so as to provide additional comfort to the user and allow the strapof the headgear to rest naturally with respect to the distal ends of themask frame.

FIGS. 13-14 illustrate yet another embodiment of a headgear connectioninterface 400E in which a strap of the headgear 20 is provided with asimple annular washer end 436. A plug 432 can then be provided theannular washer end 436 and have an interference fit with a correspondingplug adapter end 434 provided about the distal ends of the mask frame300.

FIGS. 15-19 illustrate various views of yet another embodiment of aheadgear connection interface 400G in which a strap of the headgear 20is provided with a deformable side piece 500 provided between theheadgear 20 and the mask frame 300. The deformable sidepiece 500 canattach to each arm using an interference interconnector comprising amale connection 518 and a female connector 514 as well as attached tothe headgear 20 by means of a male connector 522 and female aperture524. It will be appreciated that the relative male of female connectorsor apertures can be located selectively about either the deformablesidepiece or the interference interconnector. As shown, the deformablesidepiece 500 can be configured to attach to the each respective arm atvarious angular positions, or in other words rotate with respect to themask frame 300. Additionally, the deformable sidepiece 500 can beprovided initially as a planar member, which can then be selectivelydeformed out of plane so as to conform about the facial contours of auser. In this manner the deformable side piece can be shaped so as tofollow the contours of the user's cheeks without touching them, oralternatively touch the cheeks but equally distribute any pressureapplied thereto.

It should be understood that of the various connectors described herein,some versions are configured to have the headgear connect to the maskframe in a fixed connection (non-rotating), some allow for free rotationconnection (no interference or stops), and some have interferencemechanisms to selectively rotate or be positioned angularly about themask frame.

In one instance the deformable sidepiece is formed of a shape retainingplastic. This plastic can have a general deformation characteristicalong a single plane while maintaining some rigidity in a second plane.Other types of deformable plastic can be deformed along multiple planes.In one embodiment the cross-section of the deformable sidepiece isrectangular. The curvature of the deformable sidepiece along aparticular plane (see FIGS. 15 and 17) can be preset or formed totransfer the force of the head gear system around certain features ofthe user's face. Since user's faces have three-dimensional features thedeformable sidepiece can then conform to the remaining features of theuser's face. Thus, allowing a customizable headgear system thatmaintains a balance between rigidity and flexibility, while beingconformable to a user's unique facial features.

It will be further appreciated that the deformable sidepiece 500 mightcause a certain degree of discomfort to a user. As such, a malleablesleeve 510 can be provided which encompasses the deformable sidepiece500. The malleable sleeve can be formed of fabric, silicone, or othercomfort increasing material having any number of desired attributes,such as heat transfer rate, elasticity, softness, etc.

FIG. 20 illustrates a deformable sidepiece 500A which has a siliconeshell 560 having a malleable shape retaining core.

FIG. 21 illustrates yet another headgear connection interface 400H whichincludes a keyed post 440 located about a distal end of the mask frame300 and keyed opening 442 which slid through the keys to an innerportion 442 with a smaller diameter which allows free rotation. Theassembly can only be separated when angularly positioned correctly so asto align the keys. It will be appreciated that the keys should beprovided out of phase from each other in normal angular positionsbetween the mask frame 300 and the headgear 20 while being worn. Inorder to ensure that the keyed components do not separateunintentionally, a cap 444 can be provided which prevents unintentionalseparation.

FIG. 22 illustrates another keyed embodiment, similar to that of FIG.21. having an alternative strap portion 442A, which covers the hardware,i.e. the keyed post 440 and the associated connector inside the strap442A, so as to improve comfort and reduce the likelihood of catching themask on something while shifting during sleep and thus tearing the maskoff the user's face. This embodiment utilizes a similar plug 444A tocover the connection from the outside of the strap 442A and thus preventpremature decoupling or catching.

FIGS. 23A-C illustrate an alternative embodiment of a mask frame 600.This mask frame is more rigid and instead of interfacing with the nasalpillow assembly 100 using a rotatable sleeve, the arms of mask frame 600are rigid and do not provide rotation of the pillow assemblies 100 aboutthe respective arm portions. This embodiment provides increasedstability for headgear attachment and facial placement purposes. In thisembodiment the nasal pillows are still permitted to rotate about thepillow's central axis, wherein the pillows can have an elliptical crosssection.

In this embodiment a plurality of washout vents 604 can be provided in acentral portion of the mask frame 600. Additionally, the headgear 20 canbe attached to the mask frame 600 using any of the previously discussedheadgear attachment interfaces.

FIGS. 6E, 21 and 23A all show various placements of CO₂ washout vents.Being at a bottom portion of the pillow assembly 100, on the attachmentsleeve 150 as shown by 158 in FIG. 6E, at the ends of the right or leftarms, as shown by 159 in FIG. 21, and on the mask frame at a centralportion as shown by 604 in FIG. 23A. It will be appreciated that any oneof these placements either alone or in any combination is within thescope of the present invention. The CO₂ washout vents may be comprisedof a material that has silicone knife coated across it. In otherembodiments the CO₂ vent is a plurality of holes that have been formedtherein.

It is contemplated that the wall thickness and/or durometer of the nasalpillow portion can be varied. In one exemplary embodiment the flatunderside portion which connects the bell like top of the nasal pillowto the tube portion may have either a thinner wall portion then theflared bell like portion and tube portion or may have a lower durometervalue. This thinner wall or lower durometer value allows the tubeconnected to the flat underside to collapse into the bell like portionwhen pressure is exerted on the bell like portion. When the nasalpillows are formed of the silica material or silken like material thenasal pillow returns to its original state when no pressures beingexerted on it. Again this allows for the flared bell like portion to paythat about the tube portion when being inserted into the nasal region.The collapse ability again helps reduce pressure exerted onto the nasalregion while at the same time helping to find an optimal position thatforms a good seal between the nasal pillow and each of the nostrils.

It will be appreciated that in certain embodiments the headgear cancause a direct tightening of the pillows into the nostrils of the user,thus having a direct correlation to a sealing force. In yet otherembodiments, for example, when providing an air conform bladder, asdiscussed with reference to FIG. 7, the force applied by the headgearcan be partially directed through the air conform bladder and into themaxilla to provide a primarily a positioning force, where the sealingforce can be adjusted by changing the relative placement of the maskframe on the face, which is held by the positioning force. In yetadditional embodiments, the nasal pillows can be caused to enter into,and hold their relative position by the elastic properties of thepillows being exerted onto the inner walls of the user's nostrils ornares without the use of headgear altogether.

FIG. 24 illustrates another alternative core or mask frame 300A wherethe right and left arms are arranged to pivot or rotate about the centerof the core. In some versions the right and left arms can form a 180degree angle between each other, making the core look more like “T”shape, each arm can then be repositioned to form a “Y” shape. The anglesbetween each arm can range from several degrees to greater than 180degrees. However, most users will have the arms angled somewhere lessthan 180 degrees. This additional degree of freedom presented by thisalternative core 300A can also work with the attachment sleeves,rotatable nasal pillows as described above for a customizable fit.

In some versions the rotation of the arms is a constant and consistentmotion, which can be enabled by a pressure sliding fit between thepivoting arm and the core. In other versions discrete angled positionsare enabled by each arm locking into a groove or channel or otherdistinct locking mechanism. Some of the rotation mechanisms can functionsimilar to the locking and rotation features of the headgear interfaceassembly.

FIGS. 25-28 illustrate yet another alternative embodiment of a maskframe 300B-D. In these embodiments the mask frame 300B-D can have one ofmore apertures 710 and 710A respectively, the apertures being providedabout distal ends of the right and left arms of the mask frame 300B-D soas to provide fluid communication between the air supply channel withinthe mask frame 300B-D and a pair of air cushion straps 750 providedabout the distal ends of their respective right and left arms. The aircushion straps 750 can have an annular wall which forms a cavity 740therein, each air cushion strap 750 having an aperture 754 whichprovides an interface through which the apertures 710 or 710A canprovide fluid communication from the air channel of the mask frame300B-D into the cavity 740. The mask frame 300B-D can have a sealing lip714 which interfaces with an edge of the aperture 754 to create a sealbetween the air cushion straps 750 and the mask frame 300B-D such thatpositive air pressure provided to an interior portion of the mask frameis communicated into the cavity 740 causing the air cushion strap toexpand and provide a cushioning effect increasing the comfort of thestrap which may rest against the user's face in certain configuration.

In some embodiments the air cushion straps can be provided with aplurality of CO₂ washout vents 768 along an exterior wall, such that CO₂can be vented out of the system through the air cushion straps. TheseCO₂ washout vents 768 can be provided by knife coating or otherwiseapplying a silicone layer over a flexible and permeable material, whichthen allows for the escape of CO₂ but do not cause a significant drop inpressure of the system such that the required therapeutic pressure islost or that the air cushion straps do not inflate.

It will be appreciated, and as particularly as shown between FIGS. 25and 26 that the air cushion straps 750 can be provided as completelyhollow and as a unitary material as shown in FIG. 25, or alternativelyas shown in FIG. 26, having a deformable shape retaining core 758, beingsimilar in construction to the deformable sidepiece as discussed above.The deformable shape retaining core can be provided in a core portion orotherwise provided within the air cushion cavity, or within its owncavity, such that deforming the deformable shape retaining core canprovide the entire air cushion strap with a certain desired contour orshape. It will be understood that in preferred embodiments thedeformable shape retaining core can be provided along an exterior innerwall such that the air cushion straps inflate in a direction toward theuser's face thus creating an air cushion there between. It will thus befurther understood that holes can be selectively provided through thedeformable shape retaining core such that they communicate with the CO₂vents provided therethrough.

FIG. 27 illustrate yet another embodiment alternative embodiment of amask frame 300D being similar to the embodiment of FIGS. 25-26. In thisembodiment the mask frame 300D can also have one of more apertures 710A,the apertures being provided about distal ends of the right and leftarms of the mask frame 300D so as to provide fluid communication betweenthe air supply channel within the mask frame 300D and a pair of aircushion straps 750A provided about the distal ends of their respectiveright and left arms. The air cushion straps 750A can have an annularwall which forms a cavity therein, each air cushion strap 750A having anaperture 754A which provides an interface through which the apertures710A can provide fluid communication from the air channel of the maskframe 300D into the interior cavity of each strap. The mask frame 300Dcan have a deeper sealing lip 714A which interfaces with an edge of theaperture 754A or a female receiving portion as shown, the femalereceiving portion having an additional seal 762, which can be rubber orsome other malleable material, which is provided therein so as to createa seal between the air cushion straps 750A and the mask frame 300D. Insome embodiments a corresponding seal 762A can be provided about thesealing lip 714A so as to increase the seals effectiveness. In thismanner positive air pressure provided to an interior portion of the maskframe 300D is communicated into the cavity 740, thus causing the aircushion strap 750A to expand or otherwise inflate and provide acushioning effect. This inflated cushion increases the comfort of thestrap which may then conform to and rest against the user's face incertain configuration and equally distribute any pressure. The aircushion strap 750A can similarly be provided with a plurality ofoptional CO₂ washout vents provided therein, which can be formed fromapplying silicone over the flexible material forming the cushion strapand allows the CO₂. In some instances the silicon is applied using aknife-coating method.

FIG. 6E. 21, 23A, and 25A all show various placements of CO₂ washoutvents. Being at a bottom portion of the pillow assembly 100, on theattachment sleeve 150 as shown by 158 in FIG. 6E, at the ends of theright or left arms, as shown by 159 in FIG. 21, on the mask frame at acentral portion as shown by 604 in FIG. 23A, or on the side straps asshown by 768 in FIG. 25A. It will be appreciated that any one of theseplacements either alone or in any combination is within the scope of thepresent invention. The CO₂ washout vents may be comprised of a materialthat has silicone knife coated across it. In other embodiments the CO₂vent is a plurality of holes that have been formed therein.

In some alternative embodiments the CO₂ washout vents can be formed onthe sidepiece of the headgear system where the sidepiece does notinflate. In one version a flexible tube runs along the sidepiece thathas CO2 washout vents formed therein, but does not expand (or negligiblyexpands) with the positive air pressure being supplied to the system.Silicone and other rubber like materials tend to be more soluble to CO2and repel oxygen and other gas molecules.

While the forgoing examples are illustrative of the principles of thepresent invention in one or more particular applications, it will beapparent to those of ordinary skill in the art that numerousmodifications in form, usage and details of implementation can be madewithout the exercise of inventive faculty, and without departing fromthe principles and concepts of the invention. Further, discussion withregard to any of the specific features is intended to be forillustrative purposes, with the understanding that any feature discussedherein can be used in combination with any number of other features inany combination from any of the various embodiments. Accordingly, it isnot intended that the invention be limited, except as by the claims setforth below.

What is claimed:
 1. (canceled)
 2. (canceled)
 3. (canceled)
 4. A mask andheadgear assembly comprising: a mask frame, the mask frame furthercomprising: a core having an inlet connector for receiving a supply ofpressurized gas from a delivery tube; a right arm extending from thecore; and a left arm extending from the core, wherein each of the rightand left arms form an associated air pathway through each respectivearm, wherein each arm includes an first aperture for supplying thesupply of pressurized gas to a patient's airways; a headgear interfacelocated about a distal end of each arm, the headgear interface beingconfigured to be attached to a headgear assembly, the headgear interfacefurther comprising a second aperture for communicating a portion of thesupply of pressurized gas to an interior portion of the headgearassembly; wherein the headgear assembly includes an inflatable cushionconfigured to inflate in response to the supply of pressurized gasdelivered through the second aperture; and wherein the inflatablecushion includes a plurality of CO₂ washout vents provided on anexterior wall.
 5. The mask and headgear assembly of claim 4, wherein theplurality of CO₂ washout vents are apertures formed from a knife-coatedsilicone layer formed on a flexible material.
 6. A mask and headgearassembly comprising: a mask frame, the mask frame further comprising: acore having an inlet connector for receiving a supply of pressurized gasfrom a delivery tube; a right arm extending from the core; and a leftarm extending from the core, wherein each of the right and left armsform an associated air pathway through each respective arm, wherein eacharm includes an first aperture for supplying the supply of pressurizedgas to a patient's airways; a headgear interface located about a distalend of each arm, the headgear interface being configured to be attachedto a headgear assembly, the headgear interface further comprising asecond aperture for communicating a portion of the supply of pressurizedgas to an interior portion of the headgear assembly; and wherein themask frame includes a sealing lip configured to abut against and sealagainst a corresponding aperture in the headgear assembly.
 7. The maskand headgear assembly of claim 5, wherein the headgear assembly includesa female receiving portion having a secondary seal.
 8. A mask andheadgear assembly comprising: a mask frame, the mask frame furthercomprising: a core having an inlet connector for receiving a supply ofpressurized gas from a delivery tube; a right arm extending from thecore; and a left arm extending from the core, wherein each of the rightand left arms form an associated air pathway through each respectivearm, wherein each arm includes an first aperture for supplying thesupply of pressurized gas to a patient's airways; a headgear interfacelocated about a distal end of each arm, the headgear interface beingconfigured to be attached to a headgear assembly, the headgear interfacefurther comprising a second aperture for communicating a portion of thesupply of pressurized gas to an interior portion of the headgearassembly; and wherein the headgear assembly includes a female receivingportion having a secondary seal.
 9. (canceled)
 10. (canceled) 11.(canceled)
 12. (canceled)
 13. (canceled)
 14. A mask and headgearassembly comprising: a mask frame, the mask frame further comprising: acore having an inlet connector for receiving a supply of pressurized gasfrom a delivery tube; a right arm extending from the core; and a leftarm extending from the core, wherein each of the right and left armsform an associated air pathway through each respective arm, wherein eacharm includes an first aperture for supplying the supply of pressurizedgas to a patient's airways; a headgear interface located about a distalend of each arm, the headgear interface being configured to be attachedto a headgear assembly, the headgear interface further comprising asecond aperture for communicating a portion of the supply of pressurizedgas to an interior portion of the headgear assembly; and wherein theright and left arms pivot about the core.
 15. (canceled)
 16. (canceled)17. (canceled)
 18. (canceled)
 19. (canceled)
 20. (canceled) 21.(canceled)
 22. (canceled)
 23. (canceled)
 24. (canceled)